Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T01:59:09.942Z Has data issue: false hasContentIssue false

Chapter 12 - Breech Presentation

from Part II - INTRAPARTUM AND POSTPARTUM

Published online by Cambridge University Press:  07 May 2010

John Patrick O'Grady ,
Martin L. Gimovsky ,
Lucy A. Bayer-Zwirello  and
Kevin Giordano
John Patrick O'Grady
Affiliation:
Tufts University, Massachusetts
Get access

Summary

This chapter reviews the fundamentals of the techniques for breech delivery and the evaluative process required for appropriate management. Also reviewed are external cephalic version (ECV) and internal podalic version (IPV) and the special needs of the premature breech fetus at delivery. These concepts and approaches are applicable in all breech presentations, independent of the route of delivery. Techniques for delivering the breech fetus are assisted breech delivery, delivering the aftercoming head, and breech extraction. Piper forceps (or alternatively, Simpson or Keilland forceps) can be used for delivering the aftercoming head at the clinician's discretion. The risk that the breech fetus might become acidotic during labor and delivery is marginally greater than for its cephalic counterpart. Once a breech presentation has been diagnosed, the patient and her family can be counseled and instructed about the potential problems that might be encountered.

Keywords

assisted breech deliverybreech extractionbreech laborforcepspremature breech fetusinternal podalic versionbreech presentationexternal cephalic version
Type
Chapter
Information
Operative Obstetrics , pp. 297 - 321
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kauppila, O: The perinatal mortality in breech deliveries and observation on affecting factors. Acta Obstet Gynecol Scand Suppl 1975;44:13–9.
Hall, JE, Kohl, S: Breech presentation: A study of 1,456 cases. Am J Obstet Gynecol 1956 Nov;72 (5):977–90.CrossRefGoogle Scholar
Karp, , Doney, JR, McCarthy, T, Meis, PJ, Hall, M: The premature breech: Trial of labor or cesarean section?Obstet Gynecol 1979 Jan;53(1):88–92.Google Scholar
Sibony, O, Luton, D, Oury, JF, Blot, P: Six hundred and ten breech versus 12,405 cephalic deliveries at term: Is there any difference in the neonatal outcome?Eur J Obstet Gynecol Reprod Biol 2003 Apr;107(2):140–4.CrossRefGoogle Scholar
Gimovsky, ML, Paul, RH: Singleton breech presentation in labor: Experience in 1980. Am J Obstet Gynecol 1982Aug; 143(7);733–9.CrossRefGoogle Scholar
Todd, WD, Steer, CM: Term breech: Review of 1006 term breech deliveries. Obstet Gynecol 1963 Nov;22:583–95.Google Scholar
Braun, F, Jones, KL, Smith, DW: Breech presentation as an indicator of fetal abnormality. J Pediatr 1975 Mar;86(3):419–21.CrossRefGoogle Scholar
Axelrod, FB, Leistner, HL, Porges, RF: Breech presentation among infants with familial dysautonomia. J Pediatr 1974 Jan;84(1):107–9.CrossRefGoogle Scholar
Brenner, WE, Bruce, RD, Hendricks, CH: The characteristics and perils of breech presentation. Am J Obstet Gynecol 1974 Mar;118(5):700–12.CrossRefGoogle Scholar
Cruikshank, DP, Pitkin, RM: Delivery of the premature breech. Obstet Gynecol 1977 Sep;50(3):367–9.Google Scholar
Gimovsky, ML, Petrie, RH: The intrapartum and neonatal performance of the low-birth-weight vaginal breech delivery. J Reprod Med 1982 Aug; 27(8):451–4.Google Scholar
Green, JE, McLean, F, Smith, LP, Usher, R: Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma, and death?Am J Obstet Gynecol 1982 Mar;142(6 Pt 1):643–8.CrossRefGoogle Scholar
Gimovsky ML, Breech Delivery. in Queenan, JT, Hobbins, JC, Sprong, CY: Protocols for High-Risk Pregnancies, 4th ed. Oxford UK: Blackwell Publishing, 2005; pp. 55–8.CrossRefGoogle Scholar
Wright, RC: Reduction of perinatal mortality and morbidity in breech delivery through routine use of cesarean section. Obstet Gynecol 1959;14:758–63.Google ScholarPubMed
Potter, MG Jr., Heaton, CE, Douglas, GW: Intrinsic fetal risk in breech delivery. Obstet Gynecol 1960 Feb;15:158–62.Google Scholar
NIH Consensus Developmental Task Force statement on cesarean childbirth. Am J Obstet Gynecol 1981 Apr;139(8):902–9.CrossRef
White, PC, Cibils, : Clinical significance of FHR patterns during labor. VIII. Breech presentations. J Reprod Med 1984 Jan;29(1):45–51.Google Scholar
Papiernik, E: The role of emergency obstetric care in preventing maternal deaths: An historical perspective on European figures since 1751. Int J Gynaecol Obstet 1995;50(2):73–7.CrossRefGoogle ScholarPubMed
Hannah, ME, Hannah, WJ, Hewson, SA, Hodnett, ED, Saigal, S, Willan, AR: Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000 Oct;356(9239):1375–83.CrossRefGoogle Scholar
Committee on Obstetric Practice. American College of Obstetricians and Gynecologists Committee Opinion: number 265, Dec 2001: Mode of term singleton breech delivery. Obstet Gynecol 2001 Dec;98(6):1189–90.CrossRef
Aburezq, H, Chakrabarty, KH, Zuker, RM: Iatrogenic fetal injury. Obstet Gynecol 2005 Nov;106 (5 Pt 2):1172–4.CrossRefGoogle Scholar
Gimovsky, ML, Wallace, RL, Schifrin, BS, Paul, RH: Randomized management of the nonfrank breech presentation at term: A preliminary report. Am J Obstet Gynecol 1983 May;146(1):34–40.CrossRefGoogle Scholar
Daw, E: Hyperextension of the head in breech presentation. Am J Obstet Gynecol 1974 Jun;119 (4):564–5.CrossRefGoogle Scholar
Gimovsky, ML, Petrie, RH: Strategy for choosing the best delivery route for the breech baby. Contemporary OB/GYN 1983;21:210–5.Google Scholar
Gimovsky, ML, Petrie, RH, Todd, WD: Neonatal performance of the selected term vaginal breech delivery. Obstet Gynecol 1980 Dec;56(6):687–91.Google Scholar
O'Leary J, : Vaginal delivery of the term breech. Obstet Gynecol 1979 Mar;53(3):341–3.Google Scholar
Watson, WJ, Benson, WL: Vaginal delivery for the selected frank breech infant at term. A preliminary report. Obstet Gynecol 1984 Nov;64(5):638–40.Google Scholar
Collea, JV, Chein, C, Quilligan, EJ: The randomized management of term frank breech presentation: A study of 208 cases. Am J Obstet Gynecol 1980 May;137(2):235–44.CrossRefGoogle Scholar
Dorsten, JP, Schifrin, BS, Wallace, RL: Randomized control trial of external cephalic version with tocolysis in late pregnancy. Am J Obstet Gynecol 1981 Oct;141(4):417–24.CrossRefGoogle Scholar
Vasa, R, Kim, MR: Fracture of the femur at cesarean section: Case report and review of literature. Am J Perinatol 1990 Jan;7(1):46–8.CrossRefGoogle Scholar
Dunn, PM: Erich, Bracht(1882–1969) of Berlin and his “breech” manoeuvre. Arch Dis Child Fetal Neonatal Ed 2003 Jan;88(1):F76–77.CrossRefGoogle Scholar
Taylor, ES, ed: Beck's Obstetrical Practice, 9th ed. Baltimore: Williams & Wilkins, 1972; p. 252.Google Scholar
Danforth, DN, ed: Obstetrics and Gynecology, 3rd Ed. Philadelphia, Harper & Row, 1977.Google Scholar
Kiwisch, FA: Zur lehré von der extraction des kindes auf den füssen [A lecture on fetal extraction by the feet]. Beitr Geburtsk Wurzb 1846; i:62–71.Google Scholar
Piper, EB, Bachman, C: The prevention of fetal injuries in breech delivery. JAMA 1929;92:217–21.
O'Grady, JP: Modern Instrumental Delivery. Baltimore, MD: Williams & Wilkins, 1988.Google Scholar
Kerr M: Breech presentation. In: Myciscoyh, P, Mori, J, eds: Munro Kerr's Operative Obstetrics, 8th ed. Baltimore: Williams & Wilkins, 1971; pp. 139–87.Google Scholar
Douglas, RG, Stomme, WB, eds: Operative Obstetrics, 3rd ed. New York: Appleton-Century-Crofts, 1976; p. 600.Google Scholar
Pinard, A: Traité du palper abdominal au point de vue obstetrical et de la version par manoevres externes, précédé d'une préface de M. Pajot [Treatise concerning abdominal palpation from the obstetrical point of view and external version, preceeded by comments by Dr. Pajot]. Deuxième Ed. Paris, 1889.Google Scholar
Altabef, KM, Spencer, JT, Zinberg, S: Intravenous nitroglycerine for uterine relaxation of an inverted uterus. Am J Obstet Gynecol 1992 Apr; 166(4):1237–8.CrossRefGoogle Scholar
Oxhorn, H, Foote, WR: Human Labor and Birth, 3rd ed. New York: Appleton-Century Crofts, 1975.Google Scholar
Fernandez, CO, Bloom, SL, Smulian, JC, Ananth, CV, Wendel, GD Jr: A randomized placebo-controlled evaluation of terbutaline for external cephalic version. Obstet Gynecol 1997 Nov; 90(5):775–9.CrossRefGoogle Scholar
Ranney, B: The gentle art of external cephalic version. Am J Obstet Gynecol 1973 May;116 (2):239–51.CrossRefGoogle Scholar
Eglinton GS: The role of external version in modern obstetrics. In: Clark S, Phelan J, eds: Cesarean Delivery. Philadelphia: W. B. Saunders, 1991.
Zhang, J, Bowes, WA Jr, Fortney, JA: Efficacy of external cephalic version: A review. Obstet Gynecol 1993 Aug;82(2):306–12.Google Scholar
Christian, SS, Brady, K, Read, JA, Kopelman, JN: Vaginal breech delivery: A five-year prospective evaluation of a protocol using computed tomographic pelvimetry. Am J Obstet Gynecol 1990 Sep;163(3):848–55.CrossRefGoogle Scholar
Gimovsky, ML, O'Grady, JP, Morris, B: Assessment of computed topographic pelvimetry within a selective breech management protocol. J Reprod Med 1994 Jul;39(7):489–91.Google Scholar
Crawford, JS: An appraisal of lumbar epidural blockade in patients with singleton fetus presentation by the breech. J Obstet Gynecol Br Commonw 1974 Nov;81(11):867–72.CrossRefGoogle Scholar
Fine, EA, Brackers, M, Berkowitz, RL: An evaluation of the usefulness of x-ray pelvimetry: Comparison of the Thoms and modified ball methods with manual pelvimetry.Am J Obstet Gynecol 1980 May;137(1):15–20.CrossRefGoogle Scholar
Federle, MP, Cohen, HA, Rosenwein, MF, Brant-Zawadzki, MN, Cann, CE: Pelvimetry by digital radiography: A low-dose examination. Radiology 1982 Jun;143(3):733–5.CrossRefGoogle Scholar
Caterini, H, Langer, A, Sama, JC, Devanesan, M, Pelosi, MA: Fetal risk in hyperextension of the fetal head in breech presentation. Am J Obstet Gynecol 1975 Nov;123(6):632–6.CrossRefGoogle Scholar
Eilen, B, Fleischer, A, Schulman, H, Jagani, N: Fetal acidosis and the abnormal fetal heart rate tracing: The term breech fetus. Obstet Gynecol 1984 Feb; 63(2):233–6.Google Scholar
Christan, SS, Brady, K: Cord blood acid–base values in breech-presenting infants born vaginally. Obstet Gynecol 1991 Nov;78(5 Pt 1):778–81.Google Scholar
Clark, SL, Gimovsky, ML, Miller, FC: The scalp stimulation test: A clinical alternative to fetal scalp sampling. Am J Obstet Gynecol 1984 Feb;148 (3):274–8.CrossRefGoogle Scholar
Gimovsky, ML, Petrie, RH: The intrapartum management of the breech presentation. Clin Perinatol 1989 Dec;16(4):975–86.CrossRefGoogle Scholar
Cohen, WR, Friedman, EA, eds: Management of Labor. Rockville, Maryland: Aspen Systems Corporation, 1983.Google Scholar
Milner, RD: Neonatal mortality of breech deliveries with and without forceps to the aftercoming head. Br J Obstet Gynaecol 1975 Oct;82(10):783–5.CrossRefGoogle Scholar
Huchcroft, S, Wearing, PM, Buck, CW: Late results of cesarean and vaginal delivery in cases of breech presentation. Can Med Assoc J 1981 Oct;125(7): 726–31.Google Scholar
Vimercati, A, Greco, P, Kardashi, A, Rossi, C, Loizzi, V, Scioscia, M, Loverro, G: Choice of cesarean section and perception of legal pressure. J Perinat Med 2000;28(2):111–7.CrossRefGoogle ScholarPubMed
Gimovsky, ML: A breach with a breech. Obstet Gynecol 2002;100:613–4.Google ScholarPubMed
Kaneti, H, Rosen, D, Markov, S, Beyth, Y, Fejgin, MD: Intrapartum external cephalic version of footling-breech presentation. Acta Obstet Gynecol Scand 2000 Dec;79(12):1083–5.Google Scholar
Collaris, RJ, Oei, SG: External cephalic version: A safe procedure? A systematic review of version-related risks. Acta Obstet Gynecol Scand 2004 Jun;83(6):511–8.CrossRefGoogle Scholar
Chervanek, FA, Johnson, RE, Berkowitz, RL, Grannum, P, Hobbins, JC: Is routine cesarean section necessary for vertex-breech and vertex- transverse twin gestations?Am J Obstet Gynecol 1984 Jan;148(1):1–5.CrossRefGoogle Scholar
Medlock, MD, Hanigan, WC: Neurologic birth trauma. Clin Perinatol 1997 Dec;24(4):845–57.CrossRefGoogle Scholar
Krebs, L, Langhoff-Roos J, : Breech delivery at term in Denmark 1982–1992: A population-based case-control study. Paediatr Perinat Epidemiol 1999 Oct;13(4): 431–41.CrossRefGoogle Scholar
Krebs, L, Topp, M, Langhoff-Roos J, : The relation of breech presentation at term to cerebral palsy. Br J Obstet Gynaecol 1999 Sep;106(9): 943–7.CrossRefGoogle Scholar
Danielian, PJ, Wang, J, Hall, MH: Long-term outcome by method of delivery of fetuses in breech presentation at term: Population-based follow up. Br Med J 1996 Jun;312(7044):1451–3.CrossRefGoogle Scholar
Geutjens, G, Gilbert, A, Helsen, K: Obstetric brachial plexus palsy associated with breech delivery: A different pattern of injury. J Bone Joint Surg Br 1996 Mar;78(2):303–6.CrossRefGoogle Scholar
Al-Qattan, MM: Obstetric brachial plexus palsy associated with breech delivery. Ann Plast Surg 2003 Sep;51(3):257–64.CrossRefGoogle Scholar
Papp, S, Dhaliwal, G, Davies, G, Borschneck, D: Fetal femur fracture and external cephalic version. Obstet Gynecol 2004 Nov;104(5 Pt 2):1154–6.CrossRefGoogle Scholar
Ghidini, A, Korker, V: Fetal complication after external cephalic version at term: Case report and literature review. J Matern Fetal Med 1999 Jul–Aug;8(4):190–2.Google Scholar
Mayank, S, Kriplani, A: Fetal demise following external cephalic version. Int J Gynaecol Obstet 1997 Feb;56(2):177–8.CrossRefGoogle Scholar
Gimovsky, ML, Boyd, C: Funic presentation as a complication of external cephalic version: A case report. J Reprod Med 1999 Oct;44(10):897–8.Google Scholar
Lau, TK, Leung, TY, Lo, KW, Fok, WY, Rogers, MS: Effect of external cephalic version at term on fetal circulation. Am J Obstet Gynecol 2000 May;182(5):1239–42.CrossRefGoogle Scholar
Smith, JF, Hernandez, C, Wax, JR: Fetal laceration injury at cesarean delivery. Obstet Gynecol 1997 Sep;90(3):344–6.CrossRefGoogle Scholar
Gimovsky, ML, Vourlos, D, Baldemero, RE: A way to minimize C/S trauma. Contemporary OB/GYN 2005;(5):32–3.Google Scholar
Whyte, H, Hannah, M, Saigal, S: Outcomes of children at 2 years of age in the term breech trial. Am J Obstet Gynecol 2004;189(Suppl):S57.CrossRefGoogle Scholar
Granati, B, Rondinelli, M, Capoti, C, Carnielli, V, Bottos, M, Rubaltelli, FF: The premature breech presentation: Outcome of newborn infants born by vaginal or abdominal delivery. Am J Perinatol 1984 Jan;1(2):145–7.CrossRefGoogle Scholar
Duehoelter, JH, Wells, CE, Reisch, JS, Santos-Ramos R, , Jimenez, JM: A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus. Obstet Gynecol 1979 Sep;54 (3):310–3.Google Scholar
Westgren, M, Ingemarsson, I, Svenningsen, NW: Long-term follow up of pre-term infants in breech presentation delivered by cesarean section. Dan Med Bull 1979 May; 26(3):141–2.Google Scholar
Gimovsky, ML, Petrie, RH: Optimal method of delivery of the low birthweight breech fetus: An unresolved issue. Perinatol 1988 Spring;8(2):141–4.Google Scholar
Zlatnik, F: The Iowa premature breech trial. Am J Perinatal 1993 Jan;10(1):60–3.CrossRefGoogle Scholar
Myers, SA, Gleiden, N: Breech delivery: Why the dilemma?Am J Obstet Gynecol 1987 Jan;156(1): 6–10.CrossRefGoogle Scholar
Deering, S, Brown, J, Hodor, J, Satin, AJ: Simulation training and resident performance of singleton vaginal breech delivery. Obstet Gynecol 2006 Jan;107(1):86–90.CrossRefGoogle Scholar
Kotaska, A: Inappropriate use of randomized trials to evaluate complex phenomena: Case study of vaginal breech delivery. Br Med J 2004 Oct; 329(7443):1039–42.CrossRefGoogle Scholar
Lavin, JP Jr, Eaton, J, Hopkins, M: Teaching vaginal breech delivery and external cephalic version: A survey of faculty attitudes. J Reprod Med 2000 Oct;45(10):808–12.Google Scholar
Hauth, JC, Cunningham, FG: Vaginal breech delivery is still justified. Obstet Gynecol 2002 Jun; 99(6):1115–6.Google Scholar
Gimovsky, ML: Singleton vaginal breech delivery at term: Still a safe option. Obstet Gynecol 2004 Jul;104(1):191.CrossRefGoogle Scholar
Glezerman, M: Five years to the term breech trial: The rise and fall of a randomized controlled trial. Am J Obstet Gynecol 2006 Jan;194(1):20–5.CrossRefGoogle Scholar
Ross, S, Hannah, M, Term Breech Trial Steering Committee: Interpretation of the Term Breech Trial findings. Am J Obstet Gynecol 2006 Dec; 195(6):1873; author reply 1873–4.CrossRefGoogle Scholar
Hannah, ME, Whyte, H, Hannah, WJ, Hewson, S, Amankwah, K, Cheng, M, Gafni, A, Guselle, P, Helewa, M, Hodnett, ED, Hutton, E, Kung, R, McKay, D, Ross, S, Saigal, S, Willan, A, Term Breech Trial Collaborative Group: Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial. Am J Obstet Gynecol 2004 Sep;191(3):917–27.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×